Ncm102 Newborn Cpr2

8/7/2019 Ncm102 Newborn Cpr2

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NEWBORN

RESUSCITATION

(NEWBORN CPR)BSN 12C

MADELINE N. GERZON, RN, MM

Clinical Instructor

Davao Doctors College


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Objectives

By the end of this session, students will be able

to:

1. Define Newborn CPR

2. Determine conditions of mother that warrant

newborn CPR immediately after delivery

3. Distinguish newborn that requires CPR(resuscitation) through careful assessment

4. Identify equipment to perform newborn CPR

2


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Objectives

By the end of this session, students will be

able to:

5. Familiarize the skills in newborn CPR

(resuscitation)

6. Discuss relevant nursing responsibilities

during newborn CPR

3


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WHAT IS NEWBORN CPR?


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Newborn CPR/Resuscitation

Is an intervention after a baby is born to

help the baby breathe and to help

his/her heart beat.


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Newborn Resuscitation Algorithm


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BASIC

RESUSCITATION


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CRITICIAL THINKING


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1.Anticipation

2.Adequate preparation

3.Timely recognition

4.Quick and correct action


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ANTICIPATION

Resuscitation must be anticipated at

every birth

Every birth attendant should beprepared and able to resuscitate


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Adequate preparation


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Timely recognition

ASSESSMENT


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QUICK AND CORRECT ACTION

Skills in Resuscitation


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IMPORTANT STEPS IN RESUSCITATION

1. Prevention ofheat loss

2. Opening the airway, and

3. Positive pressure ventilation that starts within the

first minute of life


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The surface on which the

baby is placed shouldalways be warm as well

as flat, firm and clean


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Initial stabilization and evaluation..

drying, positioningthe neonate under

radiant warmer to minimize heat loss

and suctioningof mouth and nose(Tracheal suctioning if meconium

present)

This should only take approximately

20 seconds!!!

#1


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DRYING

provides sufficient stimulation of

breathing in mildlydepressed newborns

and no further stimulation is appropriate

What else?


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Stimulate the newborn as requiredby flicking its feet or rubbingits backDO NOT spank orvigorously rub a newborn baby!


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(within 20-30 seconds of birth)

is assessment of neonatal

respiration

If the newborn is crying and

breathing is normal,

no resuscitation is needed

#2


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if the chest is rising symmetrically

with frequency >30/minute, noimmediate action is needed

If there is no cry,

assess breathing!


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If the newborn is notbreathing or gasping:

immediately startresuscitation.

Occasional gasps are not

considered breathing.


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The most important aspect ofThe most important aspect of

newborn resuscitationnewborn resuscitation

Positive pressure ventilation

#3


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What is Positive Pressure Ventilation?

higher than atmospheric pressure

pushes air into the lungs

Administered either noninvasively vianasal, facial or oral masks, nasal pillows

(small cushions that fit into the nostrils),

and mouthpieces with tubing attaching

to the ventilator or invasively via

tracheostomy


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Rationale

To ensure adequate ventilation of the

lungs, oxygenation of vital organs, and

initiation of spontaneous breathing


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How?


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Ventilation can almost always be

initiated using a bag and mask

and room air


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When no equipment is available:

mouth to mouth-and-nose

breathingshould be done.


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Form a seal between the mask and the

infant's face. Squeeze the bag with two

fingers only or with the whole hand,

depending on the size of the bag


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Ventilate with 100% oxygen

for 1530 seconds.


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Adequacy of ventilation is

assessed by observing thechest movements


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After effectively ventilating for

about 1 minute, stop briefly but do

not remove the mask and bag andlook for spontaneous breathing

If there is none or it is weak,continue ventilating until

spontaneous cry/breathing begins


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If the newborn starts crying:

stop ventilating but do not leave

the newborn.


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If breathing is slow (frequency

of breathing is


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A newborn will benefit from

transfer onlyif it is properly

ventilated and kept warm duringtransport


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If there is no gasping or breathing at all

after20 minutes of ventilation: Stop

ventilation


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Care after successful resuscitation

Do not separate the mother and

the newborn.

Leave the newborn skin-to-skin

with the mother


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Care after successful resuscitation

Encourage breastfeeding within

one hour of birth.

The newborn that needs

resuscitation is at higher risk of

developing hypoglycemia. Observe suckling (why?)


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Good suckling is a signofgood recovery.


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REMEMBER!!!


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Assessment and timely recognition of

the problem..

Risk factors are poor predictors of birth

asphyxia.

Up to half of newborns who requireresuscitation have no identifiable risk

factors before birth.


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Assessment and timely recognition of

the problem..

Taking an Apgar score is not a

prerequisite for resuscitation.

The need for resuscitation must berecognized before the end of the first

minute of life which is when the first

Apgar score is taken


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ADVANCEDADVANCEDRESUSCITATIONRESUSCITATION


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A small proportion of infants fail to respond toventilation with the bag and mask.

This happens infrequently but, when it does,

additional actions must be taken.


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Endotracheal Intubation

This has shown to provide more effective ventilation

in severely depressed/ill newborns.

It is more convenient for prolonged resuscitation but

is also a more complicated procedure that requiresgood training.


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Moreover, new evidence from a

controlled trial shows that most

newborns can be successfullyresuscitated without additional

oxygen


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However, when the newborn's color does not

improve despite effective ventilation, oxygen should

be given if available.


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An increased concentration of oxygen is

needed for:

1. Meconium aspiration

2. Immature lung, or

3. When the baby does not become pink despite

adequate ventilation.


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Chest Compressions

Chest compressions are not recommended for basic

newborn resuscitation.

There is no need to assess the heartbeat before

starting ventilation.


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Chest Compressions

Compressions should be administered if the heart

rate is absent or remains


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Chest Compressions

The (2-thumb, encircling-hands method) of chest

compression is preferred, with a depth of

compression one third the anterior-posterior diameter

of the chest and sufficient to generate a palpable

pulse


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Chest Compressions

In newborns with persistent bradycardia (heart rate


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Chest Compressions

y A higher mean arterial pressure was observed using

the method in which the hands encircle the chest

compared to the two-finger method of compressing

the sternum.


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Chest Compressions

Two people are needed for effective chest

compression and ventilation.

Before the decision is taken that chest compressions

are necessary, the heart rate must be assessed

correctly.

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Ncm102 Newborn Cpr2